结直肠损伤38例诊治分析

目的探讨结直肠损伤的特点及处理的经验。方法对38例结直肠损伤患者的临床资料进行回顾性分析。结果38例患者均行手术治疗。治愈35例(92.1%),死亡3例(7.9%),术前确诊仅12例(31.6%)。一期修补或切除吻合28例(73.7%)。术后切口感染2例、肠瘘1例、腹腔脓肿1例。结直肠损伤的主要死亡原因为多发伤、出血性休克与严重感染。结论闭合性结直肠损伤早期易误诊,一期手术治疗是一种理想可行的手术方法,但必须严格掌握其适应证。早期确诊和手术治疗及控制感染可提高治疗效果。

Diagnosis and treatment of colorectal injuries

Objective To explore the characteristics and management for colorectal injuries.Methods Retrospective analysis was made on the clinical date of 38 cases of colorectal injuries.Results Thirty-eight cases proceed surgical operation,35 cases(92.1%) cured completely,and 3 cases((7.9%)) died.Only 12 cases(31.6%) were preoperatively diagnosed.One stage repair of colon or one stage anastomosis after excision of injuried colon were performed in 28 cases(73.7%).Infection occurred in 2 cases at anastomosis and 1 case of colon fistula.One case was occurred in abdominal abscess.Mortality was most often caused by hemorrhagic shock,associated organ injuries or severe secondary infection.Conclusions Closed colorectal injuries were easily misdiagnosed early.One-stage operation is one of perfect choices for patients with colorectal injuries unless the indication is strict.The early stage diagnosis and operation and infection control can improve the results of the treatment.